Author + information
- Received January 4, 2012
- Revision received August 17, 2012
- Accepted August 20, 2012
- Published online January 1, 2013.
- Waleed Ahmed, MD⁎,
- Christopher L. Schlett, MD, MPH⁎,
- Shanmugam Uthamalingam, MD⁎,
- Quynh A. Truong, MD, MPH⁎,†,
- Wolfgang Koenig, MD‡,
- Ian S. Rogers, MD, MPH⁎,
- Ron Blankstein, MD⁎,
- John T. Nagurney, MD, MPH§,
- Ahmed Tawakol, MD⁎,
- James L. Januzzi, MD† and
- Udo Hoffmann, MD, MPH⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Udo Hoffmann, Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114
Objectives The goal of this study was to determine the ability of a single, resting high-sensitivity troponin T (hsTnT) measurement to predict abnormal myocardial perfusion imaging (MPI) in patients presenting with acute chest pain to the emergency department (ED).
Background HsTnT assays precisely detect very low levels of troponin T, which may be a surrogate for the presence and extent of myocardial ischemia.
Methods We included all patients from the ROMICAT I (Rule Out Myocardial Infarction Using Computer Assisted Tomography) trial, an observational cohort study, who underwent both single-photon emission computed tomography (SPECT)-MPI stress testing and 64-slice computed tomography angiography (CTA) and in whom hsTnT measurements were available. We assessed the discriminatory value of hsTnT for abnormal SPECT-MPI and the association of reversible myocardial ischemia by SPECT-MPI and the extent of coronary atherosclerosis by CTA to hsTnT levels.
Results Of the 138 patients (mean age 54 ± 11 years, 46% male), 19 (13.7%) had abnormal SPECT-MPI. Median hsTnT levels were significantly different between patients with normal and abnormal SPECT-MPI (9.41 pg/ml [interquartile range (IQR): 5.73 to 19.20 pg/ml] vs. 4.89 pg/ml [IQR: 2.34 to 7.68 pg/ml], p = 0.001). Sensitivity of 80% and 90% to detect abnormal SPECT-MPI was reached at hsTnT levels as low as 5.73 and 4.26 pg/ml, respectively. Corresponding specificity was 62% and 46%, and negative predictive value was 96% and 96%, respectively. HsTnT levels had good discriminatory ability for prediction of abnormal SPECT-MPI (area under the curve: 0.739, 95% confidence interval: 0.609 to 0.868). Both reversible myocardial ischemia and the extent of coronary atherosclerosis (combined model r2 = 0.19 with partial of r2 = 0.12 and r2 = 0.05, respectively) independently and incrementally predicted the measured hsTnT levels.
Conclusions In patients with acute chest pain, myocardial perfusion abnormalities and coronary artery disease are predicted by resting hsTnT levels. Prospective evaluations are warranted to confirm whether resting hsTnT could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and improve the effectiveness of patient management.
- coronary computed tomographic angiography
- high-sensitivity troponin T
- myocardial perfusion imaging
- single-photon emission computed tomography
This work was supported by the NIH (R01 HL080053). The reagents for high-sensitivity troponin assays were provided free by Roche Diagnostics. Drs. Ahmed, Uthamalingam, and Rogers received support from NIH grant T32HL076136. Dr. Truong also received support from NIH grants K23HL098370 and L30HL093896. Dr. Januzzi has received grant support from Roche Diagnostics, Siemens Diagnostics, and BRAHMS. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 4, 2012.
- Revision received August 17, 2012.
- Accepted August 20, 2012.
- American College of Cardiology Foundation